Ultrasound guided bilateral rectus sheath block for post operative analgesia in patients undergoing umbilical surgeries under GA. A comparative study between bupivacaine, levobupivacaine and Ropivacaine (original) (raw)
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PRILOZI, 2017
Background: Ultrasound guided rectus sheath block can block the ventral rami of the 7th to 12th thoracolumbar nerves by injection of local anesthetic into the space between the rectus muscle and posterior rectus sheath. The aim of this randomized double-blind study was to evaluate the analgesic effect of the bilateral ultrasound guided rectus sheath block as supplement of general anesthesia on patents undergoing elective umbilical hernia repair. Methods: After the hospital ethics committee approval, 60 (ASA I–II) adult patients scheduled for umbilical hernia repair were included in this study. The group I (n=30) patents received only general anesthesia. In the group II (n = 30) patents after induction of general anesthesia received a bilateral ultrasound guided rectus sheath block with 40 ml of 0.25% bupivacaine. In this study we assessed demographic and clinical characteristics, pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after operation and total analgesic consumption of ...
Biomedical Research, 2018
Objective: In this study, we evaluated the efficacy of ultrasound guided Transversus Abdominis Plane Block (TAPB) procedure that was performed for the purpose of postoperative analgesia in patients who underwent caesarian section operation under spinal anesthesia. Patients and methods: This study included a total of 50 patients who underwent elective Caesarian section under spinal anesthesia. Patients were divided into two groups: those who postoperatively underwent guided ultrasound TAPB (Group TAPB, 20 ml. of 0.25% bupivacaine injected bilaterally); and those who did not undergo TAPB (Group C). Post-operatively, all patients received patientcontrolled analgesia using tramadol. Visual Analog Scale (VAS) scores were recorded at the time of patient's transport to and from the recovery room, and at the post-operative 1 st , 2 nd , 4 th , 6 th , 12 th and 24 th h. Tramadol consumption was recorded at the recovery phase and at 24 h. Results: Demographical data of the patients did not show any statistically significant difference. The amount of tramadol administered during recovery and at the end of postoperative 24 h were significantly lower in group TAPB (32.50 ± 15.51 and 226.00 ± 66.44 mg, respectively) in comparison to group C (47.52 ± 19.15 mg and 280.80 ± 35.34 mg, respectively) (p<0.01). VAS scores at time of transport to the recovery room, at the time of exit from the recovery room, and at the post-operative 1 st , 2 nd , 3 rd , 4 th , 6 th and 12 th h were significantly lower in group TAPB when compared to group C (p<0.05). Conclusions: It has been determined that ultrasound-guided TAPB performed after spinal anesthesia results in lower VAS scores, reduced analgesic consumption.
AER , 2017
IntroductIon After cesarean patients, pain has to be addressed effectively with minimal interruptions and complications to ensure that they are alert and comfortable to take care of their newborn. [1-3] Conventionally, opioids are administered to provide effective pain relief in the postoperative period. However, opioids are associated with dose-dependent side effects including nausea, vomiting, pruritus, sedation and respiratory depression. [4] Various regional anesthetic techniques have been tried including transverse abdominis plane (TAP) and ilioinguinal-iliohypogastric (ILIH) nerve blocks to spare opioid analgesics and achieve the same goals but the relative efficacy is unknown. Ultrasound guidance of the simple anatomic technique (ILIH) may greatly improve the success of the inguinal nerve blocks, reduce the volume of local anesthetic, and prevent potential injury of adjacent Background: Quality of postoperative analgesia after cesarean section makes difference to mother in child bonding, early ambulation, and discharge. Ilioinguinal iliohypogastric (ILIH) and transverse abdominis plane (TAP) block had been tried to reduce the opioid analgesics, but the relative efficacy is unknown. Hence, this study was designed to compare the efficacy of these two regional analgesic techniques in sparing postoperative rescue analgesic requirement following lower segment cesarean section (LSCS). Methods: Sixty patients who underwent LSCS were randomly allocated into two groups to receive either US-guided TAP block or ILIH nerve block using sealed envelope technique at the end of the surgery. In the postoperative ward, whenever patient complained of pain, pain nurse in-charge administered the rescue analgesics as per the study protocol. A blinded observer visited the patient at 0, 2, 4, 6, 8, 10, 12, and 24 h postoperative intervals and recorded the quality of pain relief and the amount of rescue analgesic consumed. Results: All patients in both the study groups required one dose of rescue analgesics in the form of injection diclofenac sodium 50 mg intravenously but subsequently 57% of patients did not require any further analgesics till 24 h in the TAP block group whereas in ILIH group, only 13% did not require further analgesics (P = 0.00), correspondingly the cumulative tramadol dose was significantly higher at all the time interval in the ILIH group when compared to the TAP group. Conclusion: Quality of postoperative analgesia provided by TAP block was superior to ILIH block following LSCS.
Background: The Transversus Abdominis Plane Block (TAPB) is a method of regional anaesthesia. After lower abdominal surgery, it produces analgesia, especially when parietal wall discomfort constitutes a significant portion of pain. By depositing local anaesthetic over the transversus abdominis muscle, it permits sensory blocking of the lower abdominal wall's skin and muscles. In a doubleblinded, prospective, randomized controlled clinical study, we assessed the effectiveness of TAPB with bupivacaine and ropivacaine for postoperative analgesia in lower segment caesarean section. Materials and Methods: TAP Block was randomly administered to 60 parturients having elective or emergency LSCS and divided into two groups. Group B-TAP Block with 0.25percent Bupivacaine 20 ml each side (n=30). Group R-TAP Block with 0.25percent Ropivacaine 20 ml each side (n=30). At the conclusion of the procedure, TAP Block was done using 20 ml of either 0.25 percent ropivacaine or 0.25 percent bupivacaine on each side. A blinded observer evaluated each patient postoperatively at 30 minutes, 2, 4, 6, 12 and 24 hours after surgery. Result: Both clinically and statistically, the outcomes in the two groups were comparable. The mean duration of analgesia was 1419.93 minutes in Group B and 1343.81 minutes in Group R, both of which had statistically significant standard deviations of ± 126.9 minutes and ± 32.18 minutes, respectively. Conclusion: When administered in a TAP Block to provide postoperative analgesia following lower segment caesarean section surgery, 0.25 percent Bupivacaine provided a comparatively longer duration of analgesia, lesser VAS Scores than Ropivacaine. Both medications have a very good safety profile. Both medications have exceptional therapeutic value in terms of dependability & potent analgesia.
IP innovative publication pvt. ltd, 2019
Introduction: It is important for parturient to have less pain and to ambulate early in order to prevent venous thrombosis and to facilitate child care. Transversusabdominis plane (TAP) block is a recent peripheral nerve block technique which is used for the lower abdominal wall surgical procedure. Materials and Methods: Study was carried out in 60 patients. Patients were randomly divided in two groups of 30 patients each by computer generated random no. method. After completion of caesarean section under spinal anesthesia, TAP block was given with 15 ml of 0.25% bupivacaine bilaterally in group Band with 15 ml of 0.25% ropivacaine bilaterally in group R. Pain severity was measured by Visual Analog Scale. Total dose and frequency of rescue analgesics required in 24 hours, effect on hemodynamic variables, side effects & complications if any were noted. Result: VAS score have significantly less in group R (P<0.0001). Mean satisfaction scores were 2.06 and 2.66 in the bupivacaine and ropivacaine group respectively (P<0.0084).Surgeon satisfaction score were 2.23 and 2.63 in the bupivacaine and ropivacaine group respectively (P<0.0235). Rescue analgesia was needed early in the bupivacaine group. Conclusion: There has been growing interest in regional nerve block techniques in recent era with significant results on efficacy, as they decrease the requirement of supplemental analgesia. TAP block is a very effective technique with excellent efficacy after various abdominal surgeries including cesarean section.
Anesthesia & Analgesia, 2010
BACKGROUND: Ultrasound-guided transversus abdominis plane block is an effective method of providing pain relief after cesarean delivery. Neuraxial morphine is currently the "gold standard" treatment for pain after cesarean delivery. In this study we tested the hypothesis that subarachnoid morphine would provide more prolonged and superior analgesia than would transversus abdominis plane block in patients undergoing elective cesarean delivery. METHODS: In this prospective, double-blind study, 57 patients were randomly assigned to receive either subarachnoid morphine (group SAM; n = 28) or transversus abdominis plane block (group TAP; n = 29). Patients received bupivacaine spinal anesthesia combined with morphine 0.2 mg in group SAM and received saline in group TAP. At the end of surgery, bilateral transversus abdominis plane block was performed using saline in group SAM or using bupivacaine 0.375% plus epinephrine 5 microg/mL in group TAP with 20 mL on each side. Postoperative analgesia for the first 24 hours consisted of scheduled rectal diclofenac and IV paracetamol; breakthrough pain was treated with IV tramadol. For the next 24 hours, scheduled rectal diclofenac was given; oral paracetamol and IV tramadol were administered upon patient request. Patients were assessed postoperatively in the postanesthesia care unit (time 0 hours) and at 2, 4, 6, 12, 24, 36, and 48 hours. The primary outcome measure was the time to first analgesic request. RESULTS: Median (range) time to first analgesic request was longer in group SAM than in group TAP [8 (2-36) hours versus 4 (0.5 to 29) hours (P = 0.005)]. Median (range) number of tramadol doses received between 0 and 12 hours was 0 (0-1) in group SAM versus 0 (0-2) in group TAP (P = 0.03). Postoperative visceral pain scores at rest and on movement during first the 4 hours were lower in group SAM than in group TAP, but were not different at any other time points. The incidence of moderate to severe nausea was higher in group SAM than in group TAP [13/28 (46%) versus 5/29 (17%) (P = 0.02)].
International Journal of Perioperative Ultrasound and Applied Technologies, 2012
Background: Transversus abdominis plane (TAP) block is a recently described technique to provide analgesia in lower abdominal surgery. The technique has been refined by ultrasound (US) guidance to deliver the local anaesthetic into the neurofascial plane between the internal oblique and the transversus abdominis muscles. We evaluated the analgesic efficacy of US-guided TAP block in patients undergoing caesarean delivery. Methods: Fifty women undergoing caesarean section were randomised to undergo bilateral TAP block with ropivacaine 0.5% (N = 25) versus placebo (N = 25), in addition to standard postoperative analgesia comprising of oral acetaminophen (600 mg) 6 hourly, with IV morphine (3 mg) analgesia for 'breakthrough' pain. Each patient was assessed postoperatively by a blinded investigator for morphine usage, average pain score, nausea, vomiting, pruritus, drowsiness and satisfaction with pain relief. Results: In the TAP group, postoperative morphine requirements up to 24 hours were significantly reduced (median 18.0 mg) compared with the placebo group (median 33 mg). Patients in the TAP group reported lower visual analogue scale scores than patients in the placebo group. Fewer patients required antiemetic in the TAP group. There were no local complications attributable to the TAP block. Conclusion: US-guided bilateral TAP block used in conjunction with oral acetaminophen significantly reduces the need for IV morphine and is an effective component in a multimodal strategy for postoperative analgesia following caesarean delivery.
Bangladesh Journal of Pain, 2023
Background: Effective postoperative pain management after caesarean section is very vital; because it helps early ambulation, facilitates breastfeeding and creates early mother-baby bonding. To reduce this significant postoperative pain various modalities are in current use. All truncal blocks can reduce postoperative pain and reduce opioid consumption after caesarean section significantly. This study aims to compare the effectiveness of USG guided Quadratus lumborum block and Transversus abdominis plane block in postoperative pain management in patients undergoing caesarean section. Methods: This randomized controlled trial study was conducted in 60 patients, who were underwent elective caesarean section under sub arachnoid block in obstetric operation theatre, Bangabandhu Sheikh Mujib Medical University. The study populations were divided equally into two groups having same numbers of parturient in each. QL block group parturient received ultrasound guided quadratus lumborum block (0.20% bupivacaine) and TAP block group received transversus abdominis plane block (0.20% bupivacaine) after caesarean section. Total volume of the drugs (0.20% bupivacaine) is 20 ml on each side. Then collected data was recorded and compared between two groups: duration of analgesia, time of first analgesic requirement, total dose of opioid consumption in first 24 hours, postoperative pain by VAS score, sedation scale by Ramsay scale and satisfaction level by Likert scale between the groups. Results: Socio-demographic profile were similar among the both groups (p>0.05). The mean VAS score was significantly low in QL block group as compared to the TAP block at 10th, 16th and 20th hours interval (p<0.05). Patients with QLB block had significantly late demand of 1st analgesic (14.35±2.55 vs 8.25±2.25) hours (p<0.05) and significantly less total opioid consumption (95.5±10.7 vs191.6±14.8) mg (p<0.05) compared to patients with TAP block. Post-operative complication was noted significantly higher among patients with TAP block compared to QL block. The level of satisfaction was much higher in QL block group then TAP block group. Conclusion: This study shows that quadratus lumborum block produce longer duration of analgesia which provides optimum post-operative pain control and reduce the opioid consumption among the patients than transversus abdominis plane block in case of caesarean section under subarachnoid block.
International Journal of Contemporary Medical Research [IJCMR]
Introduction: Patient undergoing caesarean section suffer significant postoperative pain. Transversus Abdominis Plane Block is an effective method of providing postoperative analgesia in patient undergoing lower segment caesarean section. We evaluated the efficacy of (0.25%) Bupivacaine and (0.5%) Ropivacaine for providing effective postoperative analgesia using TAPB in lower segment caesarean section. Material and Methods: Randomized controlled double blinded study was carried out in 90 female patients belonging to ASA grade 1 or 2, aged 20-35 years undergoing lower segment caesarean section. Patients were randomly allocated in two groups of 45 each (n=45). After all aseptic precautions patients were administered subarachnoid block bupivacaine heavy (0.5%) , 10mg, by 25G Whitacre spinal needle. After completion of surgery , they received TAP block with Group 1-0.5% ropivacaine (1.5mg/kg) Group 2-0.25% bupivacaine (1mg/kg) Patients were monitored for Visual Analogue scale (VAS) ,heart rate, blood pressure, SpO 2 , nausea ,vomiting, need of supplemental analgesia with in 24 hours. Results: After LSCS the Transversus Abdominis Plane Block with 0.5% ropivacaine reduced postoperative Visual Analog Scale pain scores compared to 0.25% Bupivacaine. Conclusion: 0.5% Ropivacaine provide better and long duration of analgesia as compared with 0.25% Bupivacaine and also decrease first 24 hours analgesic requirement postoperatively.